Writing with Scissors is the blog site of Howard Rodenberg, MD MPH, former Kansas State Health Director and columnist for the Journal of Emergency Medical Services (JEMS). He is a father, emergency physician, and slightly-past-fifty curmudgeon with great hair for his age. The "scissors" in question refer to those used by editors to weed out all things opinonated, controversial, or politically inappropriate...translated as "anything funny."

Wednesday, September 30, 2009

The first time I went to Las Vegas, I was introduced to the concept of the Men’s Spa. Honestly, I was a little uncertain what to expect. My previous concept of the Men’s Spa had come from frequent passes by the Paradise Parlor in Daytona Beach, it’s neon sign burning the outline of a woman and the term “FULL BODY SHAMPOO” into the retinas of any driving east towards the mainland on US 92. I had always wondered what went on it there, and finally found out when I was the local county health department director from the Environmental Health staff who had to inspect the establishment on a regular basis. (The Environmental Health staff, charged by law with insuring the health and safety of patrons at local institutions such as the Paradise Parlor, The Pink Pony, Lollipops, and The Fabulous Shark Lounge, apparently had an internal lottery to see who was assigned these prized tours of duty.)

My apprehensions about the Men’s Spa were no doubt heightened by the plethora or card-flicking sales people lining the streets of the Las Vegas Strip who are ever ready to suggest that conversation, companionship and…dare I say it…yes, even love, at least in its most transient version, can be yours for a limited time special of $39.00. (You can double your possibilities for intellectual interchange with an international troupe for only a few dollars more). And it’s clear that these hucksters have taken the advanced marketing class. Not only are there now trucks that roam up and down the strip with the names and numbers of temperate women who sit patiently by the phone waiting for your call, but the card-flickers are now wearing back-pack mounted billboards with pictures of potential paramours plastered on either side. This is all the more interesting when the exposed chest of one of the “wares for sale,” as it were, hovers just above the scalp of bald “flicker,” creating for all the world the image of a hot chick with three breasts, which might be worth seeing but seems altogether too much to handle.

Needless to say, I was mistaken about the spa. While I assume that there are institutions similar to the Paradise Parlour in Clark County, Nevada, the Men’s Spa at the Mirage was not one of them. It was, in fact, one of the signature experiences of going to Las Vegas, and one of the draws that keep bringing me back to The Strip.

The Men’s Spa at the hotel is truly a wonderful little oasis of quiet among the turbulence of plastic and neon that is Vegas. For a truly nominal fee…much less than I’ll lose in fifteen minutes playing The Frog Princess slots on the casino floor, despite that I’m only on the penny machines…you get all day access to the facility. This includes not only the expected spa amenities such as a whirlpool, sauna, and steam room, but also lounging in front of big screen TV’s or simply in a quiet room to read or nap, beverages, snacks, fluffy towels, linen robes, forceful showers with water leeched from the Colorado River, the free use of all kinds of face, body, and hair products I can’t even begin to describe (granted, I view the use of “product” as no different than voluntarily smearing road kill on your head, so I’m the wrong one to ask about these things), and opportunities for massage therapy and other forms of relaxation. And it’s also clothing optional, which, when you are forty-six and still tall and thin and well endowed both with thick hair that just won’t stay in place and… well, is actually a secret opportunity to laugh quietly to yourself when sharing the pool with a flabby guy in his mid-thirties lacking hair where he needs it and having it where he shouldn’t.

While I still pretty much cling to my Midwestern modesty, the one place in the spa where clothing is really a hinderance is the steam bath. This was a new thing for me. I had already sat and enjoyed the dry sauna, but for some reason twenty minutes in the wood-fired heat didn’t leave me feeling clean enough. So I decided to hop into the steam bath to get more sweat out of me, in the hope that this would somehow detoxify and rejuvenate my slowly aging persona.

Somewhere in the back of our minds we know how hot steam is. Very rarely, however, do we actually get to experience steam. The steam bath is a chance to get reacquainted with the forces of nature, and to realize why (at least on a small scale) that when man goes up against nature, nature ALWAYS wins (the emergency medicine corollary is that in a battle of car versus tree, the tree always wins, even if the tree has been corrupted into the form of a telephone pole). So as I walked into the steam bath, I instantly and involuntarily broke out into the most potently powerful parasympathetic perspiration episode I can recall. But that was okay…it felt great, as if all the bad things were fleeing from your body, all the microbial and metabolic cockroaches within your system suddenly had a light shined on them and were heading back into the dark crevasses of the soul.

(For those who are medically inclined, I am aware that perspiration is a function of a sympathetic response of the autonomic nervous system and not the parasympathetic chain. But the alliteration is beautiful, yes?)

If this is working so well, for my body, I thought, this is going to be great for my lungs. It’ll really clean out all the phglem, and dilate my smallest airways in the best possible way. And so, ignoring the advice of the helpful spa attendant who told me to take small breaths until well acclimated, as well as that small piece of medical knowledge that we use cool mist to open airways and steam to clean soap scum off our sinks, I enthusiastically inhaled deep lungful of air, wet, hot, and scented with whatever it is in Vick’s Vapo-Rub that makes it so delectable and stomach-rendering at the same time.

I gasped. Choked. Wheezed. Coughed. And wheezed some more. It was awful. But I hung with it, and it got better, so very much better. The fog lifted from my brain, the oxygen flowed once again to my screaming tissues, and I was good to go. It was intensely pleasurable, to be honest. Yes, it was better than…well, you know those times when you’re going through the motions, thinking really hard about Margaret Thatcher? Yeah, better than those.

One of the more interesting things about a steam bath is that it’s an extremely instructive lesson in why clouds seem solid. In a steam bath, the superheated droplets of water are suspended in the air, saturating the confines of the room. You can think of the atmosphere within the steam room as being like multiple layers of swiss cheese. At any given moment, the plane where you’re standing has a lot more holes in it (air molecules) than solid cheese (water droplets). But as you walk within the seam room, you move from one are of lots of holes to another, so you’re able to keep making progress. What you see, however, is a “solid” water droplet here, another there, but eventually there are so many layers that there’s at least one water droplet everywhere you look, so it seems like a solid wall of steam. You can walk through it, but it’s so dense and layered that you can’t see through it. So for some time after I had managed to grope my way blindly to a seat, I was only aware that someone else had entered only from the cool rush of air coming from the opening of the door. At long length afterwards…literally about four to five minutes…I could make out a vague outline of a white robe or towel on the other side of the room.

I was really able to relax…the steam bath, because of the lack of visibility and the low-pitched hum of the heaters and fans covering the sound of your breath, is actually a very anonymous place…and my robe, which I had worn into the room as a vague expression of probity, was gone as soon as it became heavy and uncomfortable, saturated with water from the steam and my own clinging sweat. And the first fifteen minutes or so were truly wonderful. But as I continued to poach, a feeling of unease set in. I was not feeling badly in any way…in fact, I physically still felt great…but I began to wonder if had started to overdo it as a neophyte. But as I was gathering my robe about me, I noticed that the Great White Bulk that had entered after me had not stirred from it’s spot.

I recognize that in many ways, I am a competitive person. One could argue that it’s a trait…and not always a good one…of those of us who carry a Y chromosome. Maybe it’s just me. But I was suddenly filled with a desire to show the Bulk, whoever or whatever it was, that I was tougher in the steam bath than it was. So I sat there, more and more uncertain about the wisdom of my approach, but increasing determined to show that I could tolerate the heat better than it could. And at last, I succeeded. It left, the note of it’s passing a second rush of air coming in through the swinging glass door. But it was not enough to just win; it had to be done decisively. I wanted this person I had never known, will never know, don’t want to know, and will never see again to carry with him forever the knowledge that he had been crushed in a battle of manly tolerance by someone he never knew, will never know, doesn’t want to know, and will never see again. So I stayed in the steam bath long enough to recite all the lyrics to three Glen Campbell songs (“Galveston,” “Gentle on My Mind,” and “By The Time I Get To Phoenix,” if you must know) before emerging victorious into the cooling antechamber.

(This is truly an aside, but I’ve been trying to work out the time frames on the latter Jimmy Webb/Glen Campbell song for a while. If by the time he gets to Phoenix, she’ll be rising, that’s probably about 7 AM assuming she works a 9-5 job. We don’t know where she is, but it’s clearly not Phoenix. Figuring he left at midnight and is driving an average of 60 MPH, that puts his departure point up to 420 miles west of Phoenix…it has to be west, for why would you go back to Phoenix if you were east of it to start? And if you’re south of Phoenix, you’d go east via I-10 through El Paso; if you were north, you’d be on via . Neither of these cities make it into the song. So I’m thinking she’s somewhere in Southern California, as Los Angeles is 374 miles from the Arizona capital. I think it’s also true that all the times referred to in the song are “her” times, not his as he moves across time zones.

He hits Albuquerque sometime during the workday, and she probably stops at lunch to give him a call. Figure she has lunch at 1 PM. That means he’s got 6 hours, or 360 miles, to travel the distance. Unfortunately, MapQuest tells me that the shortest highway distance between the two cities is 419 miles at the shortest point. So this means that in order to hit our timelines, she must actually get up for work at 6 AM, and this knocks his departure back to 11 the night before. So she must have gotten to sleep by 10, the early hour of bedtime being perfectly understandable if your day starts at 6 and you need your eight hours in order to make it through your day.

She’s sleeping by the time he makes Oklahoma. We don’t know when she turns softly and calls his name out low, but if she sleeps between 10 PM and 6 the next morning, he can easily make the 544 miles between ALB and Oklahoma City by 11 that night. Of course, we don’t know where he’s headed, but he’s gone too far north for Galveston. My assumption is that he’s looking to hit I-35 Northbound at OKC and head to Wichita to gain employment as a county utility worker.

There’s a story problem in here somewhere.)

Oh, one other tip I should share. It turns out the cucumber slices they give you to put on your eyes and are not for eating. I took the cucumbers into the steam bath with me and put them on my eyes, but I had to keep leaning my head backwards to try to keep them balanced. Eventually my neck started to hurt, but I was not yet ready to leave the steam bath. As I had no place to put the cucumber slices, I ate them. When I told this story to my wife, proud of my abilities to indulge in self-care, she informed me, in that wonderful “I-love-you-but-I –can’t believe-you’re-such-a-moron-and-they-actually-let-you-work-on-people” way that she has, that this was the wrong thing to do. (She’s had a lot of practice with this look. The first time I went to the spa, I heard a new word and asked her what a “metropolitan sexual” was. I got flicked in the head with her fingernail for that one. What she didn’t understand at the time….and what still boggles her mind…is that she married the guy who was 37 before he understood exactly why the Village People were so excited about the YMCA and the Navy. I mean, who doesn’t think aircraft carriers are neat?) While she was kind enough to assure me that the cucumbers were likely not recycled in any way, she did tell me that this behavior was a gross violation of spa etiquette, and that skin care items should not be considered as nutritional in any way. That was good to know, because when I calculated my fruit and vegetable intake for the day, I counted the cucumbers as one of my five suggested servings.

(The steam bath also provided me with great material for a potential future caper. Several months ago, the spouse became enamored with a product called “Kinouri.” These are adhesive patches full of the Colonel’s secret blend of herbs and spices that you stick to the bottom of your feet at night. When you wake up the next day, the patches have turned dark with all the toxins they have pulled out of your system. I had the temerity to suggest that maybe what was happening had nothing to do with toxin removal, but more to do with simply sweating and the moisture discoloring the patch. So what I thought I might do is wear about thirty Kinouri patches into a steam bath, emerge with all of them having turned various shades of black, and proudly proclaim my purity to her. That would no doubt earn me another flick to the head, but it might be worth it.)

The bottom line is, my adventures aside, that I love the steam bath. And the dry sauna. And the whirlpool. And the snacks and the fluffy towels and the quiet place to stretch out and read my book. And the fact that, through the beneficence of good genes and a parasite I picked up near Angel Falls, I still have a flat stomach and lots of hair in the right places, and a healthy dose of humility.

Thursday, September 24, 2009

While I'm not happy to have a divorce on my record (but just as happy that it occurred), every now and then it helps to know it could be worse. Take this guy I saw in the ER today. His complaint was that he had hot and cold feelings in his stomach. These started about three weeks ago, when a waitress at Burger King called him "sweetie," which he thought was unusual in itself. Then he noticed that his burger had something sweet in it, and he knew that "they" were trying to "hit" him again. Again, because last month "they"put bleach in a pitcher of beer and had had blisters in his mouth the next day. And then a few months ago "they" dropped a full can of Colt 45 Malt Liquor on his head. Not to mention that last August, "they" had tried to kill him in an auto accident that left him with chronic chest pain. They, of course, are his ex-wife, her mother, and the wait staff at a variety of eating and drinking establishments. But he understands why "they" are out to get him, ever since he reported that his ex-wife had left the children in the company of vagrants living under a bridge (a step even below a VAN DOWN BY THE RIVER, for you Matt Foley fanatics). And he knows that that legal system is against him, too, because a judge ordered him to have an involuntary psychiatric evaluation last February. And today I led the heath care system into the fray, running up a bill on the citizen's dime in order to document that he, in fact, does not have an acute medical emergency. This was frustrating to him as he saw something floating in his urine, and wanted me to personally watch him pass the wasteful amber fluids to check. I declined the opportunity to build further patient rapport. He departed a dissatisfied client, and I reflected that this case likely represents an unreported side effect of marital separation. I think I can get a publication out of this.

(The fact that lab tests were actually done in this patient is not only a reflection of our current medicolegal climate, where clinical judgement means nothing without copious doses of fear and technology, but is also a prime application of Sirridge's Law. The Law is named after Wild Bill Sirridge, a Professor of Internal Medicine where I went to medical school and one of my supervising physicians during my internship. Wild Bill was a country doc from the old school, the kind of guy who would tell a terminally ill patient that it was probably smarter to rent than buy.

The Law was promulgated one morning when I had admitted yet another patient with an altered level of consciousness that I surmised might be related to a serum alcohol level three and a half times the legal limit (and in those unenlightened days, the limit was 0.1, not the pansy .08 level we use now. So what if the lower level is actually a better measure of impairment? In those days, we could hold our liquor. Men were men, women were women, and sheep in Oklahoma were nervous).

Anyway, I had admittedly not done a very complete workup, figuring that if he woke up okay in the morning it would be the alcohol wearing off; if not, we might look a little closer. Wild Bill greeted this idea with disdain. He pointed out...quite rightly...that there was more to evaluating the patient with an altered level of consciousness than just thinking about his alcohol level. What if there was a head injury? How about an environmental problem, like hypothermia? A nutritional disorder with central nervous system effects? Liver failure with a buildup of toxic ammonia? How about other intoxicants? Is there underlying infection that could cause a change in mental status? The conversation was summarized in The Law: "Rody, even crocks get disease."

I haveremembered this caveat all these years, and often found his advice to be critical in patient management in the ED. But the immediate aftermath of The Law was that for the next three weeks every patient that came in drunk received an extensive workup, all of which were completely negative. This lead to Rodenberg'sCorollary to Sirridge's Law, offered at the conclusion yet another negative patient report: "Bill, sometimes you've just got to call a squirrel a squirrel."

These have been words to live by. I hope someday to find them carved on a building.)

The other day someone said I was "hysterical." I began to wonder if that was the right word. After all, the word comes from the Greek root "hystero-", meaning the uterus (see "hysterectomy"...well, actually you don't want to see one of those), which implies the word can only be used for a woman. So what's a male-specific word that means the same thing? I think the new word should be "testocular," a combination of the words testes and jocular, to designate a humorous male. However, when I ran this by a friend, she suggested that "testocular" was really more suited to replace the phrase "beer goggles," as in "I saw you looking at her last night. Were you testocular or what?"